Oral Answers to Questions

Stephen Crabb: I am grateful to the Secretary of State for that response, but notwithstanding the measures and results he referred to, one of the principal stains on this Government's reputation is without question that during a decade of economic growth, rising employment and falling unemployment, hundreds of thousands of young people were allowed to fall through the net and effectively do nothing with their lives as they were not in education, not in training and not in the apprenticeships that the right hon. Gentleman mentioned earlier. Now, at a time of economic hardship when jobs are being shared and the cupboards are bare, will the Secretary of State please tell us what measures he can bring to the table today that suggest that he knows how to bring down the number of NEETs at a time of economic difficulty?

David Lammy: The hon. Gentleman is absolutely right. He will, I hope, be aware of the work of my hon. Friend the Member for Crosby (Mrs. Curtis-Thomas) to ensure that women are represented in science and engineering. Indeed, I did some work about that with my hon. Friend in my previous role as Minster with responsibility for skills. The Government have provided direct funding, including pilot funding, to encourage women in those spheres. We are also working with training organisations and trade bodies, particularly in engineering and science, to support women in their careers, including where they are on career breaks because we recognise that when women who have been trained and have an extensive science background leave work to have children, they often come back into science employment at a lower grade, or are unable to regain the positions that they left. We want to support the work of those organisations and trade bodies to ensure that those women are pioneers within science.

Si�n Simon: I am grateful to the hon. Lady for her kind words of welcome. I think that the hon. Member for South Holland and The Deepings might be wishing he had been a little more gracious in the beginning.
	Obviously, in economically straitened times there are pressures on this sector, just as there are everywhere. One of the things that we have done is to introduce, in the particularly pressed construction sector, a construction industry clearing house for apprenticeship places, so that as people are laid off, we can try to re-find such places for them. I do not have the specific figures on the placements that the hon. Lady wants, but I shall certainly write to her with them.

Si�n Simon: I am grateful to my hon. Friend. I must say that it is not actually my job to sort it but that of Lord Young, and he will do so. As a former apprentice and a former senior trade union official with decades of experience, he is more than well qualified to sort it. My hon. Friend may know that we have set up a review involving the construction industry, the construction industry unions and the sector skills council. All the stakeholders are holding a review to examine exactly these kinds of issues and everything else that has an impact on the construction industry and apprenticeships at this difficult time. My answer is the same as it was to my hon. Friend the Member for Hove: any mistreatment, of any kind, including through low wages, needs to be dealt with, and is unacceptable.

John Denham: We will report publicly in the proper way, as we do every year when the UCAS figures come in. There is a regular cycle of reporting and we will report on those figures. I want to see a continuation of progress in university numbers in years to come, and I believe that our policies will lead to that. We will start in the fairly near future with the launch of the student finance campaign, which emphasises the benefits of the financial support that we have extended, having reintroduced grants since that were abolished under the Conservative Government. I believe that we will make the progress that the hon. Gentleman wants to see. A leaked document at a very early stage in the process is not a point from which to draw too many firm conclusions.

Harriet Harman: Autumn has not finished yet.
	The right hon. Lady asked about the Counter-Terrorism Bill and the Home Secretary's statement to the House after the defeat of the 42-day provision in the House of Lords. Our view was that it was important for the House to hear the Government's intention as soon as possible, following the defeat of the clause in the House of Lords. If we had waited until the next day, speculation would have run overnight and there would have been a great many speculative news reports; but we thought that the House would need to hear as soon as possible, and therefore the statement was brought before the House. In fact, many Members of the House were present when the Home Secretary made the statement; the Chamber was packed, and it was an extensive statement.
	The right hon. Lady mentioned the communications data Bill, which the Home Office proposed and was included in the draft legislative programme. As she will know, instead of simply announcing the Bills for the legislative programme in the Queen's Speech, we have given the public an opportunity to see the Government's intentions by publishing the draft legislative programme in early summer, enabling people to comment before the Queen's Speech clarifies the Government's fixed intention for the legislative programme. The draft communications data Bill was in the draft legislative programme, and a number of issues and concerns have been raised about it.
	The Home Secretary has made it clear that at all times on important issues such as these, she wants to listen to people's concerns, consider them and consult on a wide, bipartisan basis. She has said that instead of pressing forward with legislation in the next Session, she will seek to consult further, including publishing draft clauses or possibly even a draft Bill. The right hon. Member for Maidenhead (Mrs. May) misunderstands the position: having published the measure in the draft legislative programme, we will undertake further consultation before we introduce the Bill in the House. It sounds as though she would probably welcome that, now that I have had an opportunity to explain the position.
	The right hon. Lady talked about anti-corruption. Anti-corruption responsibility runs across a number of Government Departments. At one stage in the past, the lead responsibility was with the Department for International Development; at another stage, it was with the Department for Business, Enterprise and Regulatory Reform. It is currently with the Ministry of Justice, but the point is that all Government Departments need to focus on the issue, and indeed they do so. The question of where the lead is less important; more important is the fact that across government the agenda is delivered, and it certainly will be.

Simon Hughes: May I endorse the request from the right hon. Member for Enfield, North (Joan Ryan), as there was a very large attendance in Westminster Hall, and I am sure that there would be interest across the House among Members from all parties in a substantive debate? Ministers have always been accommodating if the time has been provided.
	May I return to matters raised by the right hon. Member for Maidenhead (Mrs. May), which are of huge significance in relation to Home Office business this week? First, to go back to Monday night, it was unacceptable that an important debate in Government time on democracy and human rights around the world was interrupted by the making of a statement in the middle of it. Why could the statement not have been made at 10 o'clock, as is traditionally the case if an urgent statement is made? We could have had the full debate as planned, and the statement, and everyone would have been alerted in the normal way.  [ Interruption. ] It was indeed about news management, as it was hoped it would be covered by the financial discussions being conducted on Monday, which, as we know, was a difficult but important day financially.
	Out of the hat on Monday night the Home Secretary produced the rabbit, the temporary provisions Bill, as her fig leaf to cover her major U-turn. If she is serious about another Bill in the wings, may we have proper pre-legislative scrutiny of it, with the opportunity to take evidence on whether it is needed? We have a provision whereby Special Standing Committees consider a Bill and take evidence. Given the widespread opposition to the Billopposition that is massive in the House of Lords, significant in this place and very large in the countrythe justification for it has not been made out, and we need to have the debate before the Home Secretary has the Bill ready to introduce.
	On the other home affairs matter properly raised by the right hon. Member for Maidenhead, I have read the Home Secretary's speech from yesterday, including her references to the communications data Bill and I understand the exchange that has just taken place, but to some of us, on the back of the DNA database, the plan for ID cards and the proposal for 42-day detention without charge, the idea of an Orwellian super-database adds the final nail in the coffin, turning us from a people of liberty to a people of suspectsa completely unacceptable proposal.
	May we have a debate, therefore, in this place so that we can hear the Home Secretary, the proposal and the representations that she has received and see whether there is any public support for the idea that every phone call we ever make and its location, for example, is kept for the rest of our lives on some great Government system? The Government do not appear to be able to hold the data that they already have, let alone any more.
	Tomorrow, we will debate private Members' Bills: there are 51 on the Order Paper. The Government have always wanted to be helpful and the job of the Leader of the House is to be helpful to private Members. The right hon. and learned Lady may know that in the past six years nine out of 10 Government Bills have received Royal Assent. She may also know that only about one in 10 private Members' Bills have received Royal Assent. Will she seriously consider ways of giving better opportunity for private Members on her own side and others to get their proposals into legislation, and not hog all the time for Government business?
	We look for an assurance today that there will be no Government guillotine or timetable on the Human Fertilisation and Embryology Bill that prevents debate on related fertilisation, embryology or abortion if colleagues on either side wish to raise them. May we have an assurance not only that we will have a full day, but that the Government will not seek to manage the business to prevent that debate?
	Lastly, we will have a welcome debate next week on the Olympic legacy and building on the Olympic achievement. I invite the Leader of the House to join me and, I am sure, the right hon. Member for Maidenhead, on the day when the nation celebrates our fantastic Olympic achievement, in saying that we are hugely proud of our athletes in both Games and many of us are greatly excited by the prospect not only of the games in London in four years' time, but of even better success then.

Hugo Swire: The Leader of the House will be aware of the continuing press reports surrounding the relationship between the Secretary of State for Business when he was EU Trade Commissioner and Mr. Oleg Deripaska, who I understand is banned from the United States following an FBI inquiry into his business activities. Given the very serious nature of some of the allegations, may we have a debate next week to try to ascertain the nature of the relationship between the Business Secretary when he was EU Trade Commissioner, in relation to the ownership dispute within the Russian insurance company Ingosstrakh and the aluminium tariffs situation in Russia?

Richard Younger-Ross: Can we have a statement on the impact of inflation on pensioners? In particular, can the Leader of the House confirm that the state pension rise next April will be at least as high as the 5 per cent. retail price index rise announced on Monday?

Edward Miliband: With permission, I would like to make a statement on the new Department of Energy and Climate Change. The new Department brings together the Government's work on three long-term challenges that face our country: ensuring that we have energy that is affordable, secure, and sustainable; bringing about the transition to a low-carbon Britain; and achieving an international agreement on climate change at Copenhagen in December 2009. Those are our goals, and the new Department recognises that when two thirds of our emissions come from the use of energy, energy and climate change should not be considered separately, but together.
	Some people will ask whether we should retreat from our climate change objectives in tough economic times. In our view, it would be quite wrong to row back, and those who say that we should misunderstand the relationship between the economic and environmental tasks that we face. Of course, there are choices to be made, but there are also common solutions to bothfor example, energy-saving measures for households, such as those announced by my right hon. Friend the Prime Minister in September, which cut bills and emissions; or investment in new environmental industries, which both improves our energy security and reduces our dependence on polluting fuels. What we know from the Stern report of 2006 is that the costs of not acting on climate change are greater than the costs of acting on it. Only if Britain plays its part will a global deal in Copenhagen to cut carbon emissions be possible, so far from retreating from our objectives, we should reaffirm our resolve.
	Over the summer, the Secretary of State for Environment, Food and Rural Affairs, to whom I pay tribute for his work and leadership on climate change, asked the independent Committee on Climate Change to review the long-term target for Britain's emissions. Based on a Royal Commission report in 2000, the target had been set at a 60 per cent. reduction in CO2 emissions. Since then, independent reports have added further to our knowledge. Arctic sea ice has melted faster than expected, global emissions have grown faster than expected and the impact of each degree of climate change is known to be worse than expected.
	Last week, Lord Turner wrote to me with the committee's conclusions, which have been placed in the Library of the House. His report found that to hold global warming to 2 above pre-industrial levelscommonly accepted as the threshold for the most dangerous changes in the climateglobal emissions must fall by between 50 and 60 per cent. by 2050. Lord Turner concluded that to play its proper part, the United Kingdom should cut its emissions not by 60 per cent. but by 80 per cent. He concluded that the target should apply not just to carbon dioxide but to all six Kyoto greenhouse gases. He also concluded that while there were uncertainties about how to allocate emissions from international flights and shipping, they too should play their part in reducing emissions.
	The Government accept all the recommendations of the Committee on Climate Change. We will amend the Climate Change Bill to cut greenhouse gas emissions by 80 per cent by 2050, a target that will be binding in law. I hope that Members on both sides of the House will support that move. Indeed, let me say that I want to create as much of a consensus as possible on climate change. However, as we all know, signing up to an 80 per cent. cut in 2050, when most of us will not be around, is the easy part; the hard part is meeting it, and meeting the milestones that will show we are on track. For us in Britain, the milestones will be shaped by the recommendations of the Committee on Climate Change, which will advise us in December on the first 15 years of carbon budgets. That means national limits to our total emissions, within which we shall have to live as a country. We will report next year on how we will meet them.
	We are also determined to ensure that the signal and the commitment come not just from Britain but, as the Prime Minister has been making clear in recent days, from Europe. That means an agreement by the end of this year on strengthening the European Union emissions trading scheme, and on the targets for 2020: that Europe should reduce greenhouse gases by 20 per cent. unilaterally and by 30 per cent. as part of a global dealtargets that I reaffirm todayand that the EU should confirm its renewable energy target.
	Earlier this year, we published our draft renewable energy strategy. Having examined the issue, I can say that what is clear to me is not only the scale of the challenge, but the urgency of getting on with the delivery. The renewables obligation has tripled supply in the past five years, and we are making further changes in its structure, in planning policy and in access to the grid. However, having heard the debate on the issue, including what has been said by many colleagues on both sides of the House, I also believe that complementing the renewables obligation for large-scale projects, guaranteed prices for small-scale electricity generationfeed-in tariffshave the potential to play an important role, as they do in other countries. Having listened to the views that have been expressed, including those expressed in the other place, we plan to table an amendment to the Energy Bill to make that happen.
	I believe that renewable power can play a bigger role not just in electricity but in heating. Heating produces almost half Britain's carbon emissions, and cleaner sources of heat can help us to meet our target in 2050 and the milestones on the way. I recognise that we need to make rapid progress on that issue as well, and I will make further announcements soon.
	Our objective is a climate change policy that is fair and an energy policy that is sustainable. The present structure of the energy market was designed in a world of abundant supply, British energy self-sufficiency, low commodity prices and an emerging debatebut not a settled consensuson the issue of climate change. Today, all those assumptions have changed. There is international competition for resources and a need for new investment in supply; there are structurally higher energy prices; and there is urgency about carbon emissions. To respond to this new world we need a market that secures future supply, which must include investment in nuclear power and carbon capture and storage. We need a market that provides incentives for cuts in emissions and does more to help homes and businesses.
	Those are the big issues that we need to address for the future, but today I want to signal a direction of travel on affordability. Last week the energy regulator, Ofgem, highlighted what it believed to be unjustified higher charges for 4 million electricity customers in areas not connected to the gas main. It also believes that, even when account is taken of higher costs facing companies from customers with pre-payment meters, many homes that use them are being overcharged.
	Unfair pricing that hits the most vulnerable hardest is completely unacceptable. I made that clear to the representatives of the big six energy companies when I met them yesterday. I also told them that the Government expect rapid action or explanation to remedy any abuses, and I will meet them again in a month to hear what they have done. We, and Ofgem, are determined to see those issues addressed. Ofgem is consulting on its findings until 1 December as part of a due process, but let me say this: if the companies do not act satisfactorily and speedily, we will consult on legislation to prevent unfair pricing differentials.
	For us, markets can provide enormous benefits in dynamism and efficiency, but they will only work properly if they are regulated effectively in the public interest, including with a strong independent regulator. There is more to be done to help consumers, and we will not hesitate to act. We need an end to unfair pricing, feed-in tariffs for electricity generation, and an 80 per cent. cut in emissions.
	Our aim is a climate change and energy policy which is fair and sustainable, and which meets our obligation to today's and future generations. That is the work that we are beginning in my new Department, and I commend my statement to the House.

Greg Clark: I warmly welcome the right hon. Gentleman's statement, and welcome him personallyalong with his ministerial colleaguesto the Front Bench. I also welcome him to the Dispatch Box, where he appears for the first time in his new post.
	The Secretary of State is widely regarded as one of the most personable, thoughtful and respected members of the Government. Our debates have always been civilised and productive, and it is certainly my intention that our exchanges on this most important issue for our country's future should remain so. I thank him for allowing early sight of his statementalthough not quite as early as that secured by  The Guardian and the Politics Home website, which published most of the statement this morning. I remind him that the true home of politics in this country is Parliament, and that it should have been through Parliament that the statement was first released. But, for all that, we welcome it.
	Conservative Members agree that the choice between ambitious and progressive action on carbon reduction and a successful, powerful economy is, in fact, not a choice at allthey are one and the same. Without decisive action, there is a risk that climate change will leach away huge resources from this country and every other nation on earth. The economic events of recent days have proved that catastrophic risk must be acted on rather than wished away. Does the Secretary of State acknowledge, however, that we start from a position of disadvantage? There has been a decade-long void in the Government's policy on energy, in which successive Ministers have looked the other way rather than addressing the issue of our future energy needs. Does the Secretary of State accept that to the intrinsic difficulties of making choices on energy have been added the consequences of a decade of indecision?
	It was Conservative Members who first called on the Government to publish the Climate Change Bill, which we have sought to strengthen through scrutiny in this and another place. We have been called here today for the Secretary of State to announce a new target, but does he share his predecessor's view that the Government are unlikely to meet their 2010 target of a 20 per cent. cut in emissions, despite three successive manifesto pledges? We support his acceptance of the Climate Change Committee's target of 80 per cent.we have always said that we should be guided by the science on thatbut, as he knows, eight years ago 60 per cent. was considered to be the right target. Does he agree that the committee should keep the target under constant review, and that if the advice changes, so must the target?
	Does the Secretary of State share our view that the move to decarbonise our economy should involve leading the way in new technology and practices at home, rather than simply buying in permits from other countries? If he agrees with that, does he also agree that the Climate Change Committee should advise on the right balance between domestic and traded reductions? Does he accept that his predecessors have been paying lip service to carbon capture and storage without decisive action? Will he commit himself to our policy of funding at least three CCS demonstration projects, so that Britain can lead the world in this vital technology?
	If the Secretary of State is serious about decarbonising our economy, will he give us a guarantee by adopting our emissions performance standard, whereby no plant will be licensed if its emissions are worse than those of a modern gas-powered station? Will he acknowledge that decentralised generation offers a vital way for our citizens to cut their fuel bills and emissions, and inject greater resilience into our energy supply? I welcome his belated acceptance of our case for feed-in tariffs for micro and small-scale generation; however, it is regrettable that his statement appeared to contain nothing about tariffs for renewable heat and gas. Will he also now recognise the case for smart metering, which will enable customers to profit from microgeneration? Finally, will he tell us how many vulnerable people he now expects to be in fuel poverty by 2010, the date by which the Government have committed themselves to eradicating it?
	Gas customers without pre-payment meters pay up to 40 per cent. more than those using online direct debits and, according to Ofgem, the cheapest online offers may be below costin other words, the poorest are subsidising the well-off. We look to the Secretary of State to act through his conversations with Ofgem and the companies, so that the poorest get the most help, not the least.
	We welcome the measures that the Secretary of State has proposed today but, as with our public finances and our financial system, on energy and climate change, we are hobbled byhow would his friend the Prime Minister put it?a decade of irresponsibility. Britain cannot afford the years ahead to be wasted like the years that have passed.

Steve Webb: I also warmly welcome and congratulate the right hon. Gentleman on this critical role within government. I also congratulate the Government on following the Lib Dem lead from nine months ago and putting energy and climate change into a single brief. However, I want the right hon. Gentleman to be even more powerful than he is because we will tackle climate change effectively only if he also has control over pretty much the rest of the Government as well. Is it not the case that, in the week that he was appointed, one of his ministerial colleagues said, We will expand Stansted airport? What is the point of having a climate change Minister who has no clout with the rest of the Cabinet? I urge the Secretary of State to wield a big stick around the rest of the Cabinet and ensure that not just energy and climate change decisions, but all other Government decisions are taken through a green lens.
	I welcome the move to the 80 per cent. target. Can I save the Secretary of State some trouble? He does not need to table a fresh amendment. He can simply accept mine: amendment No. 1 to the Climate Change Bill, which deletes 60 and inserts 80. It is on the Order Paper, and I will be honoured to have his name added to it.
	On a serious point, can the Secretary of State clarify the coverage of the 80 per cent. target? He used some vague words in his statement about aviation and shipping playing their part, but he did not say that they were included in the 80 per cent. target. Is not excluding aviation and shipping from the 80 per cent. target like being on a calorie-controlled diet but not counting the cream cakes that one plans to eat? Surely, we have to count the big polluters and the rapidly growing polluters in the target.
	On the issue of domestic effort, we fully appreciate the importance of saving emissions at home and abroad, but is it not the case that the Climate Change Bill would allow every single saving to be brought in? We do not have to save any domestic emissions at all under the Bill. Surely the Secretary of State, when he goes to international forums, wants to set the lead? Is there not some floor that he is willing to set that insists that the British domestic effort is substantial?
	The Secretary of State had a meeting with the energy companies yesterday, the latest in a very long line of cosy chats with them that have delivered precisely nothing. Is it not time, not for more cosy chats, but for action? His statement says that, if the energy companies do not play ball, he will threaten them with consultation on legislation. Have not hard-pressed customers had to wait long enough?
	Today, I have published figures that show that the poorest four fifths of single pensioners will on average be in fuel poverty this winter; the figures were produced by the House of Commons Library based on Office for National Statistics projections. That is totally unacceptable. Waiting another month and then consulting is too late for pensioners this winter. Will the Secretary of State act far more urgently than that?

Edward Miliband: Let me start by paying tribute to my hon. Friend for the great work he has done on this issue. He started much of what was in my statement on the energy side. I know that people across the House and across the energy industry have the highest regard for the work he has done on these matters, and I look forward to carrying on working with him in the new role that he has around global energy markets.
	On my hon. Friend's climate change question, I completely agree that we must confront the siren voices who say we should retreat and row back from these commitments, partly because we know that the longer we wait the worse the problem will get, and partly because, as I said in my statement, we know there are ways in which we can address both the economic issues we currently face and the long-term climate change questions.
	I also have a lot of sympathy with what my hon. Friend has said on the issues of fuel poverty and affordability, and I am urgently looking into that by asking what more can be done, as soon as possible, to help such vulnerable people. Let me make just one other point, however, which refers back to my statement. We have a market system that was designed 20 years ago in completely different times, and some of the issues that we are now facing are symptomatic of having a differently designed system created some time ago. Therefore, there is a whole set of questions that we need to consider to do with how we can fundamentally tackle the issues my hon. Friend raised in his second question.

Edward Miliband: My hon. Friend makes an important point. I think that the 1 per cent. to 2 per cent. recommended by Stern was for 2050, so we have some time to get there. I shall take that as a homework point to go away and examine. Working out the direction of travel for public spending and what will be required is an important part of the attempt to tackle climate change.

David Winnick: I think that there is a differenceat least, I hope so.
	I welcome my right hon. Friend's statement, but will he accept that there is bound to be anxiety up and down the country at the increase of some 35 per cent. to 40 per cent. that is being implemented in domestic prices? Would it not be useful if, when he met the energy companies, he would be a little tougher and make it clear to them that those increases should be cancelled? If not, why not a windfall tax?

Celia Barlow: My constituents will greatly welcome the measures announced today, especially the 80 per cent. target, which I called for in February. However, many of my constituents live in houses in multiple occupation. What can be done to assist them not only with prepayment meters, but to achieve the target and become more green, which is what they want?

Fiona Mactaggart: Like everyone else, I welcome the statement, and I am especially looking forward to the letters that I shall write to those many constituents who have asked about a cut of 60 per cent. and feed-in tariffs. In his increasingly public meeting with the energy companies yesterday, did my right hon. Friend get a commitment from them that the very poorest people, who are on enforced prepayment meters, will pay the lowest tariff?

Edward Miliband: It is fair to say that there is further to go with the energy companies on these issues. There are two questions, and we must be clear about them. First, the energy companies claimcurrently supported by Ofgemthat the cost to the companies for people with prepayment meters are higher than for other people. I am urgently investigating that claim. The second issuealso raised by the Ofgem reportis that even taking account of those higher costs, people on prepayment meters are paying too much. On that point, I have demanded urgent action from the companies. On the first issue, I am investigating the truth of those claims and what can be done about the issue in general.

Michael Clapham: I welcome the establishment of a new Department. It is long overdue. We had an energy Department, as you will be aware, Mr. Deputy Speaker, up to 1992. Since then, energy has been part of the integrated remit of the DTI. That has taken the focus away from some of the real issues, so it is good that we now have a Department of Energy and Climate Change.
	I want to concentrate on two things. The first is the increase in energy prices, especially gas prices and the knock-on effect on electricity prices. There are now just six energy companies in the market. There is an oligopoly. There are more inputs into the gas market, but the peculiarity of the gas market has meant that we have seen quite high gas prices. They have increased by 30 per cent. in the past year and electricity prices have increased by 50 per cent. That has had an enormous impact on domestic consumers and industry.
	When the Business, Enterprise and Regulatory Reform Committee took evidence from the Energy Intensive Users Group in spring, we were told that gas prices in France and Germany were 30 per cent. below those in the United Kingdom. I understand that across Europe electricity prices are 5 per cent. below UK prices. That has put British industry in a difficult position. Its competitiveness was challenged by those prices.
	When we look at why energy prices have increased, we see the indexation of gas prices to oil prices. The Select Committee took evidence from Energywatch. We were told by the chief executive that it was an irrational indexation and that there were other ways in which we might move. I accept that it would require an international endeavour, but I urge the Minister to consider whether we could embark on such an endeavour to separate gas prices from oil prices. The increase in gas prices has caused great hardship across the economy. As a result of the linkage between gas prices and electricity prices, high gas prices have driven up electricity prices. We have 33 per cent. of our electricity generated by gas and because those stations are the last to be called onthe marginal stationsthey set the electricity price for the whole market. High gas prices mean high electricity prices, because the marginal set that is called on is gas-fired. That causes enormous problems.
	The hon. Member for Wealden (Charles Hendry) mentioned price increases and when he was chided by my hon. Friend the Member for Barnsley, Central (Mr. Illsley) he said that we cannot look back and that we should not dwell on the past. However, the two factors that had an impact on the energy market came about as long ago as 1989. The Conservative Government allowed the use of gas in power stations. Until then, the use of gas in power stations had been restricted. Using gas in power stations has burned an enormous amount of gas, to the extent that this year2008-09the UK may be importing 40 per cent. of the gas we use. It is estimated that the figure will go up and that by 2018 the UK will be dependent on imports for 80 per cent. of its gas.
	The other decision that had a big impact on the energy market was that of the Conservative Government to abandon all the research that had been done on clean coal technology; they demolished the research unit at Grimethorpe colliery. That removed our lead and gave it to other countries, such as Scandinavia. China, too, is making a lot of progress on that technology. A number of factors have an impact on the price of gas. If we are to deal with them meaningfully, it will require international endeavour.
	The big six are in a much more influential position in respect of electricity, with an enormous say on electricity prices in the market. That does not mean that they sit down in smoke-filled rooms and come to an agreement on the price, but because there is an oligopoly of only six major electricity producers the price signals from one to the other are easily picked up and consequently they follow each other. Over the past year, all the energy companies have increased prices. To be fair Scottish and Southern Energy did not increase its prices in April; it waited until the end of the winter. Nevertheless, all the companies have increased their prices, by 50 per cent. and 30 per cent. for gas and electricityand that has had an enormous impact.
	What can we do to deal with electricity prices? Is there a way to reduce them? The price of oil has already come down from $146 a barrel in July to $81 a barrel this week. That means that the gas price has also started to fall, which is likely to bring down inflation from the 5.2 per cent. announced this week. At the same time, we have to be aware that there will be a fall in economic activity in the UK that will also have an impact. Although on the one hand, energy prices are beginning to fall, on the other we shall have to deal with a difficult situation with more people out of work as the economy begins to slow.
	The Government can do more to deal with the situation, especially with regard to the EU emissions trading scheme, where the energy companies are set to make an enormous amount of money. They have been given free permits and Ofgem reckons that the price of carbon will increase by 9 per tonne, so taking that figure right across the industry, the companies are likely to make 9 billion over phase 2 of the European emissions trading schemefrom January 2008 until 2012. There is an opportunity to consider whether there is room for a windfall tax on that windfall profit. An enormous amount of profit will be made, so there is an opportunity and the Minister may already be considering the possibility of a windfall tax. We could use that money to start to tackle the big issue of fuel poverty.
	The hon. Member for Wealden asked how many people were already in fuel poverty as a result of the price increases. We know that for every 10 per cent. increase in energy prices, 400,000 households are put into fuel poverty. When we consider the gas price increase of 50 per cent. over the past year, we realise that we could be talking about 2 million households being put back into fuel poverty. The energy companies have a social responsibility. If they do not make money available to deal with fuel poverty from the profits they are making, the Minister must seriously think in terms of a windfall tax.
	There is another aspect that we must look at carefully. The one thing that we could not do in the BERR Committee when we looked at energy prices was determine where the profit was coming from. On the one hand, the wholesale gas price goes up and on the other hand, because 30-odd per cent. of electricity is generated from gas and gas prices increase in relation to oil, the price of electricity also brings a profit. There are large profits in the wholesale area of gas usage and the Minister may want Ofgem to concentrate on that in its regulation of the energy industry. If that can be done, it could provide another opportunity to work with the energy industry to tackle fuel poverty.
	All in all, a number of things can be done. We need transparency in the forward gas market, which is not there at present. Some gas companies, in previous acquisitions, bought companies that had long-term gas contracts, and the Minister may want to consider whether those contracts are anti-competitive and what we might do to loosen them up so that they are conducive to more competition. That certainly needs to be looked at.
	We should also look at the enormous amount of profit that will come from phase 2 of the European emissions trading scheme. In the Minister's previous role, he was close to what was being done on clean coal technology and carbon capture and storage, but there has been such delay. I understand that this year we have listed four companies for further negotiation, but we are not likely to choose one for a contract until next autumn. That is too long. We need to expedite carbon capture and storage. That is not just to deal with coal-fired stations, although that is an important aspect; a gas-fired station produces about half the CO2 emissions of a coal-fired station, so we need to ensure that we use carbon capture and storage on gas-fired stations as well.

Steve Webb: The hon. Gentleman makes an important point. I will return to the issue of home insulation programmes.
	I shall stay on the issue of fuel poverty, and the figures that I referred to earlier this afternoon. I asked the Library to look at single pensioners, to rank them by quintile from the poorest to the richest, and to look at what they spend on fuel and what their actual incomes are. The Library projection, on figures provided by the Office for National Statistics, was that not just the poorest quintile were on average in fuel poverty this autumn, but the second, third and fourth poorest quintiles. All quintile groups except the top fifth were on average in fuel poverty this autumn. The scale and the urgency of the problem are absolutely incredible.
	The Minister said that two thirds of a million customers were on social tariffs. That is great for the two thirds of a million, but that must mean that if fuel poverty is running at well over 3 million, and possibly at 4 million or more, the vast majority of people in fuel poverty are not getting social tariffs. It is not just that the glass is half full or half empty; it is about a sixth full. That is the scale of the problem. So how do we get social tariffs through to the fuel-poor on a much greater scale?
	I want to address the issue of the companies. The Secretary of State has had a meeting with them and that is great; his predecessor had meetings, and the Prime Minister has had meetings, but we are not getting out of them what is needed. The Secretary of State saidI believe he did so in  The Guardian this morningthat he hoped that the companies would not pass on the cost of the home insulation scheme to consumers, but he can hope all he likes; the companies can do it, and the consumer can do nothing.
	Surely, Ofgem should be stopping the companies passing on the costs of these social measures. If it is a duty on the companies, the customers should not be forced to pay. The shareholders should be forced to pay, because as was said in a previous contribution, the generatorsnot the distribution companies, although obviously there are some pretty close linkshave had this huge windfall, according to Ofgem. In my view, one does not have a windfall tax that takes the money off them and then spends it; one places a duty on them to do the things that one wants them to do. In our view, we go very much further down the track than the Secretary of State said in terms of neighbourhood energy efficiency.
	The problem with the carbon emissions reduction target is that a road with six houses can be served by the six different companies, and six different men in six different vans can go down to help that company achieve its CERT obligation. As the hon. Member for Stroud (Mr. Drew) said, there are great variations in the types of houses and in different areas. We need a neighbourhood-based approach on a massive scale. The problem with Warm Front is that it adopts a piecemeal approach, although it has done good work. Local authorities know their neighbourhood. The answer will be different in Stroud and in South Gloucestershire, for example. We need substantial money from the supply companiesa windfall duty on themto deliver systematic energy efficiency. Yes, as the Minister said, they can provide benefit advice tooif someone is going to knock on those doors, they might as well ask that set of questions as wellbut I think there is a paucity of ambition here. Literally millions of pensioners are affected, and I would mention, too, disabled people below pension age who do not qualify for the winter fuel payment but who may face extreme heating bills that they have no choice but to incur.
	There is a serious worry this winter, particularly for people on pre-payment meters, about self-disconnection. We do not see those people in the headline figures, and I hope that the Minister will ask the energy companies how much that happens. People on pre-payment meters simply do not have the money to top them up, and they just switch off the power. That does not feature in disconnection statistics, because no one disconnected themthey disconnected themselves. That could well be a hidden disconnection scandal that gets worse this winter. There are some serious issues for consumers, as the problem is imminent. Further consultation on possible legislation simply does not meet the scale and urgency of that problem.

Siobhain McDonagh: I do not propose to speak for long this afternoon, as I have secured an Adjournment debate on a similar subject tomorrow. I have called the debate on behalf of my constituents, Michelle and six-year-old Jayden, who had their gas cut off by Scottish Power in June and who have been left without cooking, heating and hot water for four and a half months. I am concerned that Michelle and Jayden's story is just the tip of the iceberg, and that thousands like them are being treated just as badly by the energy providers.
	I am pleased that this has been chosen as the subject for today's topical debate, because it enables us to raise an important principle: should people like Michelle and Jayden be left in the cold when they have no chance of paying what the utility companies demand of them? I do not intend today to go into how they got into arrears, but Scottish Power has been charging them an incredibly high amount for their gas: 75 a month for a small, two-bedroomed housing association flat. That seems like a very high tariff to me. We all know that people on low incomes are rarely on the most generous tariff. This has been a cause of real concern, and the Government need to do morein line with today's statement and the meeting with the companies yesterdayto stop the poorest being charged the most. As I am sure everyone in the Chamber today knows, prepayment meters penalise people heavily. Ofgem says that people who use them pay 125 more than people who pay by direct debit.
	However, Michelle and Jayden are in such a bad position that they actually want a prepayment meter so that they can cook a meal, have a bath and heat their front room. But Scottish Power says no. It says that it cannot do it, and that Michelle needs to have extra pipework done in order to install a prepayment meter, and that that is not its responsibility. Scottish Power says that it is the responsibility of another utility company, Southern Gas Networks. Southern Gas Networks says, Fine, we'll do the work, but it will cost 350. And, after all that, Michelle is going to have to pay a CORGI-registered engineer even more to fit the meter. So, even though Michelle is in great need, she has been told that she has to pay for everything. That cannot be right. Not only are the utility companies ripping off our least affluent constituents by charging high tariffs, but they are trying to get them to pay hundreds of pounds for the privilege of having a prepayment meter that no one here today would want, and I am told that all this is legal.
	Scottish Power does not seem to be particularly bothered. Its best effort to justify its behaviour has been to tell me that it did not know that Michelle was on income support, or that Jayden was six and that he lived in the same house as his mum. It also says that it has not been able to get through to Michelle, but, to be fair to her, every time I have called her, she has answered my calls quickly and has always been prepared to provide even the most uncomfortable information. Just yesterday, Scottish Power admitted that Michelle had called it on numerous occasions, although until then, it was adamant that it did not know about her circumstances and that she had refused to return its calls. From my experience of Scottish Power, I can easily believe that it would not have asked her about her circumstances. I wonder whether the Government would consider ensuring that questions about people's circumstances were legitimately asked, and that it could be proved that they had been asked. I want the Government to do something about companies such as Scottish Power, which now knows everything about my constituents but still refuses to budge. It still wants Michelle and Jayden to pay hundreds of pounds that they clearly do not have, for a meter that none of us would ever want.
	I will go into more detail in the Adjournment debate tomorrow. This practice is simply not right. It might be legal, but none of us would regard it as right to leave a family without hot water, heating or cooked food for four and a half months, and into the long-term future. Trying to charge Michelle around 500 for a new meter that she cannot afford is not right. I do hope that Ministers will listen to this debate and reflect on this story.
	The utility companies spend an enormous amount on public affairs. Scottish Power is part of a company that made profits of 200 million last year. I hope that it will reflect for a moment on what it would be like to be my constituents. It is time that the utility companies learned the importance not only of talking about social responsibility but of living it.

Ben Bradshaw: One moment we are criticised for having too much of a strategic plan from the centre, and the next for not having one at all. By referring to Darzi centres, the hon. Gentleman is confusing his terminology in the same way that the hon. Member for Banbury did. He may be thinking of the polyclinic model, which is certainly part of the likely emerging health landscape in London but which I suspect is not something that most areas of the country will pursue.
	The new centres will give people the flexibility to visit a doctor at almost any time of the week, at a time that is convenient to them, while remaining registered with their own GP. The benefits will be immense, especially for people who commute or spend long periods away from home, for students who want to remain registered with their doctor at home but who want access to healthcare where they are studying, or simply for people whose own GP does not open in the evenings or at weekends.
	As well as the new GP-led health centres in every area, and in order to help tackle further health inequalities, the NHS is establishing 112 new GP practices in the areas of greatest need and where there are fewest GPs per head of population. The Jubilee line heads from here in Westminster to Canning Town in east London, and the average life expectancy of people whose homes pass overhead along the line falls by a year for each of the seven stops along the way. The ratio of GPs to population also falls dramatically. Based in the community, the GP's surgery is in the front line in improving health and tackling inequalities.
	Increasing the number of primary care clinicians in an area can therefore be the single most cost-effective way of improving the health of that population. Yet the most deprived areasthose most affected by poverty, an ageing population and rising levels of obesityare usually the very ones that have the fewest GPs, so funding new practices in the areas of greatest need will have a decisive impact. They will help remove long-standing inequities in health provision in England and improve health outcomes for the local population. More practices will also mean greater choice for local people.
	I mentioned earlier that we were always looking for ways of improving GP services. One of the aspects of the existing contract that has come in for criticism, in my view justifiably, has been the minimum practice income guarantee. It has protected the historic income of GP practices that would otherwise have lost out when the new contract was introduced in 2004. It was right for that time, but as GP pay and conditions have improved, we believe that it has outlived its purpose. It reduces the incentives for popular GPs to take on more patients, thus constraining real patient choice, and it is not closely enough related to GP performance.
	We are very pleased that earlier this week the British Medical Association agreed that the time had come to end GPs' reliance on that source of income. On Tuesday we announced that in 2009-10 we would take the first step towards abolishing the MPIG.

Ben Bradshaw: Given the time lag in terms of the impacts on health outcomes, it is inevitable that the evidence will take some time to come through, but the hon. Gentleman might note the advances we are already making on mortality rates for some of the long-term conditions and killer diseases that have disproportionately affected people from the lower socio-economic groups. We are already making progress in that regard and GPs are firmly convinced that the QOF has helped. The more we change and reform the framework in the way I have just outlined, the more we will tackle the inequalities that he and I and all Members want tackled.
	The new agreement also introduces valuable improvements to the framework. It recognises and rewards high-quality patient care and has a stronger focus on health outcomes. As well as rewarding and providing incentives for good clinical outcomes, we want to ensure that patients feel they have been treated with courtesy and respect. That is why, earlier this year, we announced in the next stage review that a greater proportion of the incentive payments made to GPs in the future will be based on how good the public feel the service provided was, based on our comprehensive annual patient survey. The 2008-09 patient survey will provide even more information about whether practices are getting the basics right. Do patients have the option of a telephone consultation? Are they listened to and treated with respect? What is their experience of out-of-hours services? What GPs are paid will directly reflect the standard of accessibility and convenience that they offer.
	The Government are overseeing the greatest expansion in primary care since the creation of the health service 60 years ago. We are investing in new practices and new services. We are putting patients at the centre of health care planning. We are giving patients a greater choice of when and how they see a GP. That is not an alternative to existing primary care provision, and it will not undermine GP practices; it is an addition to existing services. Patients now enjoy an unprecedented quality of service. Their views are translated into local action and their desire for a more convenient and accessible high-quality NHS is being brought to life.
	Primary care is the cornerstone of the national health service. It is where we all turn first when we or our families need health. I am pleased to report that in its 60th year primary care is in excellent health. With continued investment and reform under this Government, it will get better still.

Andrew Lansley: The hon. Lady is in the hands of the Chair, who determines matters such as the timing of debates. If the Chair felt that I were being excessive in the use of time, I have no doubt that he would stop me.
	I have never seen a better description of the central role of primary care than that offered by Barbara Starfield, professor of health care management at Johns Hopkins university in America. In one way, it is surprising that an American academic can understand it, but I suspect that she can see it, not least because there is often a lack of such primary care infrastructure in America compared with the UK, and there is envy of our primary care system, particularly our family community physician service. She said:
	Primary care deals with most health problems for most people most of the time. Its priorities are to be accessible as health needs arise; to focus on individuals over the long term; to offer comprehensive care for all common problems; and to coordinate services when care from elsewhere is needed.
	There is lots of evidence that a good relationship with a freely chosen primary-care doctor, preferably over several years, is associated with better care, more appropriate care, better health, and much lower health costs.
	All those things are true, but as hon. Members will recall from previous debates, defining primary care in those terms also helps us to identify some of the central problems of the Government's approach to primary care.
	Primary and secondary care are too often separated from each other. Family doctorscommunity physicianshave too little control over care. They do not have enough ability to manage the care for their patients, so the thing we are all looking formore integrated care, focused on the needs of patientscannot be delivered.
	People's relationship with their GP is being undermined by the Government's Martini strategyAny time, any place, anywhere. From the Government's point of view, it is good enough that the patient is seen by somebody, whereas from the public's point of view, it often matters a great deal who one is seen by. Awareness of that seems to have disappeared. The atomisation of primary care in the Government's hands is one of the central problems. It is not that the Government think primary care access unimportant, but the way they are going about it is undermining one of the most important aspects of primary care.
	The Minister raised a number of subjects, and I shall mention one at the outset. He said at the start that he would illustrate how, in primary care, the patient voice was being listened to, but I did not detect that in anything that he subsequently said. Apart from the fact that a lot of the Government's thinking seems to have been dictated by some of the results from the GP patient survey, the patient voice as such, in any qualitative sense, seems to have disappeared from primary care. Patients are supposed to be able to exercise choice. If the Minister really wants to know what we most want to achieve, we want to achieve a situation where patients have choice and voice, which has not happened.
	I have been at this Dispatch Box talking about health for my party long enough to recall responding to a statement by the Secretary of State in January 2006 on the community White Paper called Our health, our care, our say. One of the things in that document, which we supported, was the intention that patients should be able to exercise greater choice about their general practitioner; but it has not happened.
	For example, where is the incentive to take on new patients? This week, the Minister said for the first time that the announcement about increasing the global sum in relation to the correction factor means that there should be a greater incentive to take on new patients, but it has taken nearly three years to get to that point. In January 2006, it was stated that we could expect something on the expanding practice allowance, but it has not happened. The same promise was repeated in the next stages review published in June 2008, as though two and a half years had just passed by and nothing had been done inside Government.
	The Government promised, in January 2006, that they would stop general practices being open but full. It did not happen. What happened? The promise was repeated in the next stages review: We are going to do it now. Well, two and half years have gone by.
	The Government said, in January 2006, that walk-in centres would be reviewed. I was listening out for walk-in centres. They did not occur. If you had asked me, Mr. Deputy Speaker, before the Government went down the route of polyclinics, What actually should Government be doing? this is what we would have saidI think that the Liberal Democrats probably agree with this. First, encourage and incentivise more practices in under-doctored areas, and make sure that practices working in the most deprived communities have genuine incentives, rather than perverse incentives, to do so. Across the country, ensure that people can maintain their registration with the practice of their choiceand that they have greater choice. There is a need and a wish for patients to be able to access care on a more discretionary basis, not always having to go to their own practice. Actually, that was what walk-in centres were all about.
	The logical thing to do is not to set up new polyclinics, the purpose of which is not to be open from 8 am to 8 pm seven days a week, but to look at the walk-in centre pilots and ask how we can make walk-in centres do that job in the places where they are necessary. My hon. Friend the Member for Banbury (Tony Baldry) has left the Chamber, but he made a good point. The Government have told primary care trusts to do it, and they are doing so in places, mostly of their choosing, that do not necessarily relate to that need.
	There may well be a need for a walk-in centre in Oxfordperhaps there is such a centrebut in that city as, for my part, in Cambridge, where there are lots of tourists, students and people who, because they are commuters, sometimes find it difficult to access their local GP, the idea of a walk-in centre is a perfectly reasonable one. In 2006, the Government said that they would review walk-in centres and create the right incentives across primary care to look after unregistered patients, but they did not conduct such a review. They said that they would allow people to register near their work, rather than their home, but they have not done so. I am afraid that the things that the Government said that they would do have not been done, so the House will forgive us if we are less than confident about the Government's intentions.
	None of this has allowed patient choice to occur, but neither has patient voice had an impact on primary care. Community health councils have been abolished in England. Patients forums have been abolished in England, and it is very difficult to establish what is happening on local involvement networks in many places. The people who are most able and willing to support serious qualitative input by the public and patients who wish to engage with the quality of their health care have found that their contribution has been so disparaged and undermined by constant Government changes that they have walked away. We have to change that.

Andrew Lansley: Yes, it is depressing. Indeed, what the hon. Gentleman describes is consistent with what the Audit Commission said in its document earlier this year. It said, understandably, that the few practices where GPs had grabbed hold of practice-based commissioning and were using it creatively tended to be the same ones that had substantial experience of fundholding, so they are responding only now, 11 years later.
	I do not want to go back to fundholding. I want to develop GP commissioning that is relevant and applicable to every GP practice, so that they can all use the kind of freedoms that came with fundholding. More to the point, however, I want to do that within a better accountability framework, in which the PCT's role is that of strategic commissioner, if necessary policing the boundary between commissioning and provision, and in which patients exercise greater choice than under fundholding.
	We are talking about access to primary care, but the Minister did not mention dentistry, as though dentistry in primary care did not exist. If my hon. Friend the Member for Hemel Hempstead (Mike Penning) catches your eye, Mr. Deputy Speaker, I hope that he will have time to say something about dentistry. The Minister did not talk at all about the process of accessing urgent care. However, for many patients, one of the central issues is how they can get hold of somebody. That obviously includes the out-of-hours service, which is, at least in theory, an extension of general practice, out of hours. However, that has not been true of the out-of-hours service since the introduction of the new contract, because the service has been taken away from GPs.
	We know that in many places GPs continue to manage out-of-hours services through co-operatives. My personal experience is that where that happens, GPs and patients locally find that the still service meets more of their objectives. Indeed, I am surprised that the Minister did not speak positively about the benefits of that, since Devon Docs, which operates out of his constituency and which I had the privilege of visiting earlier in the year in Marsh Barton.

Andrew Lansley: I am sorry; I should not have given way. My hon. Friend the Member for Hemel Hempstead will say something about primary care access to dentistry later. I will leave that to him, because I know that he feels strongly about it.
	I do not want to go on about the out-of-hours service in detail, but it is just not good enough for Ministers to treat access between 8 am and 8 pm, five days a weekor even including the weekendas a sufficient answer to the issues that the public have raised. The GP patient survey does not touch on out-of-hours services to find out what patients' experiences are. We need to ensure that GPs feel that the out-of-hours service properly integrates with the service that they provide during the week, and we need to ensure that it is more accessible from the patients' point of view.
	This is all part of an urgent care approach. Interestingly, the Next Stages review documents all over the country are saying that we need to reform access to urgent care, but no one is doing anything about it. My hon. Friend the Member for Hemel Hempstead might add to this later. It is clear that we need to think hard about how people first approach the NHS. If they want to go to a walk-in centre, that is fine. But if they want to pick up the telephone, they often find themselves not really knowing whether to ring NHS Direct, their local GP, a different number for the out-of-hours service, another number for a dental service or 999. They are not sure about any of these things, even in an emergency. In fact, the figures demonstrate that large numbers of people end up ringing 999 when there is not an emergency.
	We need to arrive at a position in which there are just two numbers. If there is an emergency, people should ring 999. If there is not, they should ring another number. Clearly there is work to be done regarding that other number, because I understand, having spoken to Ofcom, that the numbers that we could use are being progressively taken by others across Europe. We have to do this on a Europe-wide basis, and others across Europe are taking the relevant 116 numbers. If we do not get our skates on, the proverbial beach towels will have been laid across all the numbersand we can guess who is doing that.
	Access to primary care is not confined to GP practices. It also includes health visitors. I suppose we all choose to cite numbers selectively to serve our purpose, but it is astonishing that, although the Minister can get up and tell us how many additional practice nurses there are, he will not tell us how many health visitors there are. Health visitors are also instrumental in the process of delivering better health care. Their numbers have been declining: we have seen a 10 per cent. decline in the past three years. We saw 800 health visitors leave the profession in 2006, while only 330 were being trained, even though there were nearly 800 applicants for such posts.
	We need to restore a more universal health visiting service. We, at least, have made it clear that we will make a start by making the resources that were to be used for outreach workers at Sure Start centres available for health visitors who would see mothers when they came home shortly after their babies had been born and see them through those first few weeks. That would be instrumental in delivering an improvement.
	The Minister said that he wanted to improve access to pharmacy. I will not go on at length about pharmacy, but pharmacists are constantly being led up the hill. They were led up the hill over the pharmacy contract. They were told that, instead of the old scheme, they would have a new scheme in which their payment would increasingly be geared to the commissioning of additional services, particularly in the area of public health, such as screening. They are now being told the same thing again, three years after the previous pharmacy contract. That did not happen before, and all their expectations were frustrated. They believe that it will happen again now. At the moment, however, I see no evidence that primary care trusts are launching into this processindeed, quite the opposite.
	If we look at the way in which the Government are approaching the cardiovascular risk assessment programmethis was part of the quality and outcomes framework announcement in relation to the GP contractwe see that it is being geared to be delivered through GP practices. There is good evidence, however, that we do not have the risk-assessment tool available to see what the Government are planning to do, still less the cost-benefit evaluation that supports it. At least, there ought to be an opportunity for pharmacists and pharmacy chains to offer the same service on the same basis. As far as I can see, the information that triggers the risk assessment can be gained in a pharmacy as readily as in a GP practice. If we are talking, as we often are, about men in their 40s and 50s who probably have no reason to be visiting their GP, but find themselves in pharmacies from time to time, this may well be a more convenient and acceptable way for them to access pharmaceutical services.
	Let me move on to polyclinics. The Minister behaves as if these are somehow an accomplished fact. In many places across the country, we are just beginning to realise what the evidence showsmy hon. Friend the Member for Banbury (Tony Baldry) made clear what was happening in his area and it is occurring elsewherewhich is that the choices made by the primary care trusts, entirely at the behest of the Government who told them to have a polyclinic in every area, are entirely inappropriate in the view not only of local GPs, but of local populations.

Andrew Lansley: As the hon. Gentleman is extolling larger practices and the benefits of extended opening hours and increased access for patients, can he explain why the GP Patient Survey shows that on all five measuressatisfaction with telephone access, 48-hour access to GPs, advance booking, appointment with a specific GP and satisfaction with opening timesthe performance of small practices with fewer than 2,000 patients was better than the performance of large practices with more than 15,000 patients?

Neil Gerrard: All I can say is that I observe what has happened on the ground. What I observe is that people are able to see their GPs more quickly, that they are seeing them in better premises, and that where GPs are grouped together, they frequently offer better access to patients than single-handed practices. That is not to say that single-handed practices cannot workI can think of examples that work wellbut I remember what it was like when we were almost entirely dependent on such practices.
	For people who have jobs where they are paid hourly, taking time off during the week is not a trivial thing to do. It costs them money. Many people in permanent full-time jobs may be able to have a half-day holiday, but if an hourly paid worker takes half a day off, it costs them half a day's pay.
	There are some issues about extended opening. GPs still have some issues with that. They need to sort out them out and they need help with that. Obviously, if they are going to have extended opening hours, they will have to have receptionists and support staff there for longer. That is not always easy, particularly in smaller practices. Extended opening hours benefits patients. It certainly benefits local hospitals as it keeps people from attending accident and emergency when that is not appropriate.
	We still have too many people who are not registered with GPs. In an area such as mine, that is partly because of the nature of the population. There are significant numbers of people there who come from cultures where primary care does not exist, or does not exist in a form that would be recognisable to them.
	Non-registration used to happen because of closed lists and because people found it impossible to find a GP they could register with. Now, with the new GP contracts, the vast majority of my local GPs are opening their lists up and trying to attract patients. It is possible now for everyone to find a GP and to get to see them.

Howard Stoate: I entirely accept that point, which is important and worthy of closer examination, and I want to develop it in more detail.
	Many patientsoften vulnerable onestend to accept what they are told. If they are told, There's no appointment, come back tomorrow morning and you might be able to get one, they often do so. They are thus less likely to appear in the figures as missed 48-hour appointments. Other patients who may understand the system better and say, I know I'm entitled to an appointment within 48 hours are more likely to be given one. That explains to some extent why people in more disadvantaged areas are more likely to accept what they are told and less likely to demand their rights than those in areas with more vociferous and middle class patients.
	It is entirely possible for practices, perhaps unwittingly, to deflect patients for 48 hours, and such patients would not be picked up by the surveys. It would thus appear that they were performing better. I find it difficult to accept that situation. Why can many practicesit is probably even the majorityprovide a perfectly good service? They have no difficulty whatever in combining 48-hour access with appointments booked two weeks in advance. Why do so many patients and practices have no problems, whereas others seem to run into difficulty time and time again?
	We need to go back a long way and look at the origins of primary care in the health service in 1948, when, as Members know, independent contractor status was conferred on GPs. The system has served the UK remarkably well. It has managed to ensure that because GPs are independent contractorsin effect, private businesses working on a profit and loss accounttheir only payment mechanism is the bottom line of their practice profits. Those profits are the GPs' income, because there are no shareholders; the GPs share the profits as directors of the company. That has had an enormously beneficial effect on British general practice, and it explains why it is still one of the envies of the world. It is fantastically cost-effective. GPs are focused on what they do very well indeed and the system is extremely cheap, which is one of the things I want to consider. Our system, which is cheap, cost-effective and has served us well, has also allowed quite marked variations of practice and circumstances to build up. Let me suggest one explanation for that.
	Remarkably, over that time no Government have seriously challenged independent contractor status, and no Government have seriously looked behind it at exactly what it means. In fact, what it boils down to is that GP practices have been taken for granted. It has just been assumed that GPs are professionals, do a good job, look after their patients, do what they need to do and produce reasonably good outcomes. No one has ever looked beyond that.
	One the one hand, depending on which side of the fence one is sitting, one might say that that is a huge vote of confidence in the British general practice system, which has served us well. Others might say that it is mind-bogglingly complacent, because no one has ever looked very closely behind it. It is hardly surprising, therefore, that quite a variable quality has been built into the system.
	Under the old red book system, GPs were remunerated in a way that was purely beancounting. They were paid according to the number of patients and of services provided. One added them up on paper and sent the piece of paper off to what was then the family health services authority, and it sent back a cheque each month. That was that.
	The 1990 contract, introduced by the Conservative Government, extended that arrangement a bit by producing 27 outcome measures. GPs fulfilled those measures: they sent their pieces of paper off; they got paid. They were process measures, not output measures. They looked at how many patients had their blood pressure checked, how many had a new patient examination and how many had been given advice for obesity. Not once were GPs to produce any evidence that they had done any good by that method.
	All Members in the Chamber this afternoon have spoken about quality and outcome, yet the words quality and outcome effectively did not exist until 2004, with the new GP contract that this Government introduced. For the first time, GPs were measured on the quality and the outcome of what they were doing. The indicators in the QOF are all evidence-based. They are all carefully thought through by a panel of independent experts; agreed between the profession and the NHS Confederation as being the right indicators; and carefully monitored. The question is not how many patients' blood pressure has been measured, but what percentage of those patients have blood pressure within a certain rangewhat percentage of diabetics, for example, have cholesterol levels below 4, not how many people's cholesterol levels have been checked. The intention is to measure the number of patients whose measures have been improved, thereby leading to improved patient outcome on an evidence-based system. Ironically, although all hon. Members on both sides of the Chamber bang on about the need to improve the QOF, before 2004 it had never even been properly considered. This Government deserve a huge vote of confidence for doing that.
	I should like to take issue with my GP colleagues, but not only with them. There is variable quality, and some of it is down to GP practice; sometimes GP practices could, should and must do better. I intervened on the Minister to draw attention to the problem of 0844 numbers, which is an example of where GPs have not been very friendly to their patients. He needs to look at that. It is obvious to me that some GPs could and should do more, and I believe that with a bit of incentive they probably will be able to sort that out. The fact is, however, that we have allowed the variability to continue for too long.

Howard Stoate: No. It was a response to the Government wanting to put a GP-led health centre into my area. The GPs have taken up the idea with a vengeance. They have seen that there is a gap in provision in the area. There is a new development around Ebbsfleet International station in my constituency, which will see many thousands of new houses and businesses moving into the area, and they recognise that there will be a need for new health facilities in the area. My local hospital has also looked forward to the expansion of its services as the population rises. That is entirely natural.
	What is important is that the GPs feel themselves to be supported, properly resourced and adequately advised by the primary care trust to make sure that the scheme is a success, because they want it to be a success. My point to the Minister is that if we are to make sure that GPs are willing to pick up the baton and run with it and produce extra services, we must send out a message that we are supporting them in the same way as we expect them to support their patients. I have heard from Members in all parts of the House that currently there is a real gap between the thinking of GPs who want to get on with the scheme and their perception of how the Government see them. That leaves something to be desired. I hope that my hon. Friend will look into that.
	The hon. Member for North Norfolk (Norman Lamb) mentioned the Dispensing Doctors Association and the view that we should be careful about how we handle dispensing practices. I am pleased that the consultation leaves four options open, and that the Government do not yet have a preferred view on how dispensing practice is dealt with. It is possible that when the consultation is finished, things will stay as they are. I emphasise that dispensing practices are a useful resource in some rural areas and provide a very good service to patients. I would like to make sure that that is not damaged.
	The other side of the coin is to ensure that pharmacy also has good access to patients. As has been mentioned in the debate, pharmacists can and already do provide a range of services that is expanding all the time and can be an important part of primary care delivery in the front line. I am pleased to see them expand those services. I am pleased, too, that the Government took seriously the report on the future of pharmacy from the all-party pharmacy group, which I chair. The report has received favourable comments from Ministers and I am pleased that have examined closely some of our suggestions on how pharmacy might be progressed. That is a positive development.
	GP patient access is fundamental to how people see the health service. General practice is the front line of the health service. Ninety per cent. of all care takes place in a primary care setting. The majority of people see their GP or their GP practice three, four or five times every year. If we can ensure that we build on general practice, not only can we improve patient outcomes and patient well-being, but we can keep hospitals free of cases that are less serious and ensure that they can get on with the heavy duty and high-tech cases that only they are equipped to deal with. If we get that right, we will have a health service that we can be proud of and continue to be proud of into the future. I am sure that that is what everyone in the House wants and what Ministers want.

Richard Taylor: It is a delight to follow the hon. Member for Walthamstow (Mr. Gerrard). Having trained in London rather a long time ago, I know what the standard of general practice was then, and I am very pleased to hear that it is so much better.
	I am delighted to follow the hon. Member for Dartford (Dr. Stoate), because he has removed the need for some of what I had intended to say. I had intended to stand up for GPs, because their morale is incredibly low. Indeed, after I talked to my GP he sent me a few thoughts:
	Why are we under attack when we are efficient, good value for money and valued by our patients?
	His practice spends precisely 2 per cent. on management, because the doctors do most of the management. This is his perception:
	Government has no idea of what we do and what we achieve. The fiasco of out of hours shows this. As did our over performance in QOF. Which should be a thing of celebration not criticism.
	Consultations are now highly complex. Minor illness is dealt with by nurse practitioners. We are dealing with complex cases inadequately supported by the acute trust.
	My GP's description supports what the hon. Gentleman said about timings in the day almost to the minute. GPs start work at about 7:30 am and finish at 6:30 pm. Six hours and 40 minutes are taken up in consultations, with 34 patients seen, but GPs are also engaged in making telephone calls, writing referrals, looking at reports, making home visits and so on. They therefore fully justify their pay. I hope that the Minister will acknowledge that to make GPs feel a little less disregarded and insufficiently appreciated.
	I know that our time is limited, so I will focus the rest of my speech on out-of-hours care, which is crucial. Access to out-of-hours care, which is not the function of A and E departments, is what has really brought the Healthcare Commission ratings on emergency care down. Years ago, GPs provided out-of-hours care, which meant that they were working night and day, which was not very good. As a patient, one felt guilty about ringing up a GP in the middle of the night, knowing that they had been working all day. Then we had the local co-operatives, which were excellent. They were a conglomeration of the local GPs working together in a rota to cover the nights, so that they did not have to work in the day as well.
	Unfortunately, we lost the co-operatives when the contract was introduced. It was amazing that GPs were no longer expected to work at weekends, which meant that PCTs had to provide out-of-hours care. However, in my area and many others that has not been a success. I am pleased to say that the PCT in my area realised that it had to reform the service, which was put out to competitive tender. Rather to my surprise, a conglomerate of GPs from Suffolk has taken over the provision of out-of-hours care in the whole of Worcestershire.
	I am so far very pleased with the intentions of that firm, although I am going to follow its progress closely. There is a bit of a flaw in the contract, which was short sighted but understandable, in that the firm covers only the patients of GPs registered in Worcestershire. Unfortunately, the rest of my hospital covers the area right on the Shropshire border, so when patients from Shropshire, from as little as three or four miles away, turn up in the middle of the night with something rather nasty, the firm says that it cannot take them, because the contract is not with the Shropshire GPs. I am looking into the matter, because it is in the firm's interests to take more people, because it will get the money for doing so. That was a difficulty with the contract when it was first written, but I am optimistic that it will be improved.
	The one thing that would most helpfully improve out-of-hours care has been mentioned, which is a single telephone number. If people are really desperate, 999 is fine, but we want another number. As I have said before in similar debates, people do not know whether to contact out-of-hours care or go the minor injuries unit, the A and E department or the walk-in centre. They do not know who to ring in, so we want one number. In previous debates with the Minister, he has said that he is looking into the supply of a single number.
	An organisation called NHS Pathways operates a brilliant triage system that has been trialled in various parts of the country, and those trials have been successful. I have here the minutes of the AGM of the North East Ambulance Service NHS Trust, where NHS Pathways was trialled:
	The year also saw confirmation that the clinically-based assessment systemNHS Pathwayswas a safe and efficient method of call handling...The clinical evidence-base underpinning it means NEAS is in a position to assess calls from a much wider range of patients, not only those who have chosen to access the '999' number, and to use alternative pathways of care that can be referred to from the system that is most appropriate for the patient's needs.
	The trust has already noted areas of significant improvement, including a considerable reduction in the number of patients going to A and E departments unnecessarily.
	NHS Pathways is a marvellous triage system, and if itor something similarcould be accessed from a single phone number, it would be a huge help, particularly for out-of-hours care. I should very much like to find out from the Minister whether he will push NHS Pathways as a useful form of access, and whether we can aim to have a single number.

Peter Bone: I am grateful for that intervention, which adds to my point that there are big differences around the country. My argument is that imposing one GP-led health centre in every PCT is not right.
	This morning, three hon. Members who are currently in their places were sitting in the Health Committee. We heard that the Government have found 250 million of taxpayers' money to inject into primary care. However, 150 million is going into a minimum of one health care centre per PCT, and we do not know how the other 100 million will be divided up. I was trying to understand the best way of allocating that money so that it was focused on the areas that needed it most, and I suggested a very simple system.
	The Government devote a lot of time, concern and expense to working outon the basis of deprivation, growth and other factorswhat each and every PCT needs as a minimum, but they do not fund every PCT to that level. Because some areas are overfunded, others are underfunded. My Northamptonshire PCT happens to be the worst funded in the country, so I declare a certain interest in finding a solution. Surely it would be better to take this 250 million and give it to the PCTs that are underfunded according to the Government's own criteria, and then let them develop local solutions to their problems.
	I have another idea for raising some extra money to put into the pot. Why not get rid of the strategic health authorities? I cannot see that they do anything other than push pieces of paper about and tick boxes. The only criterion that an SHA takes into account as making for a good PCT is ticking all the boxes; it does not take local need or local decision-making into account. What we should do is get rid of all those pen pushers, take this money and put it into primary access.

Peter Bone: I should hate to include that question in my survey. If I asked Do you value your GP or me?, it would be like the election return in an African republic: 100 per cent. would value the GP and none would value me. So, with all respect to my hon. Friend, I do not think that I shall include that question.
	The question Why do people put health first or second? leads to another question. A number of Members have said that many people make their local hospital their first call, because they can obtain primary care in the accident and emergency department, and they are not sure where they should go or cannot see their GP. I only wish that we had that option in my area. We do not have a hospital, although an area of that size should obviously have one, and if my PCT were funded correctly, it would have one.
	As for access to GPs, Wellingborough has one of the worst GP-patient ratios in the country. Because the town is expanding, people coming into it cannot get on to GPs' lists. They have to be forced on to them through the PCT. Again, the position varies considerably around the country. I feel that rather than there being all these plans and targets, money should be found to provide more GPs. We are lagging behind the rest of Europe when it comes to GP numbers. We are asking GPs to do moreto work longer hours, or to work at weekends and take time off during the week to compensatewhich is not at all helpful.
	On average, a GP sees 34 patients a day. Goodness me! I shall sit down at 9.30 tomorrow morning, and after I have seen 12 of my constituents, I shall be completely worn out. The fact that our GPs see 34 people who are really ill in a single day is an extraordinary testament to them.
	Out-of-hours access is never an issue in my constituency. The doctorsor the doctors and the PCThave worked it out. Many surgeries stay open in the evenings, but, as was mentioned earlier, there are doctors' co-operatives running night-time services. I have a seven-year-old. He was ill one nightnot ill enough for us to dial 999 and take him to a hospital, but ill enough for us to ring NHS Direct, which told us that we should use the out-of-hours service. When we went to the out-of-hours service, we were seen very quickly and it was a first-class service. In my area, there is no demand for polyclinics or GP-led health centres, but the Northamptonshire PCT had planned to put three in the county. Sense has prevailed and that has been knocked back to one, which no one seems to want.
	The hon. Member for Dartford made a strong case about how GPs in his area were embracing the scheme and bringing it forward. That is the way in which it should happen. If people want to do it, they should do it. In my constituency, there was a doctor's surgery that was already planning to move to a bigger location and to add services. That is the sort of thing that is evolving and should be encouraged, but local doctors are concerned about funding.
	The Minister will probably pull me up on this, as I will not use the right terminology, but, as I understand it, if there is a polyclinic or a GP-led health centre in the town, it will attract people because of the out-of-hours service and the seven-days-a- week service. People will register with that centre, which is how it will be funded in due course, and move away from existing surgeries. It is rather like cherry-picking. The people who tend to be healthier will go to the GP-led health centre and my surgeries will be left with the more difficult casesnamely, the elderly and the young. Those surgeries have to spend more time on them, but because it is a per capita funded system, their income will go down. Therefore, they will spend longer with the patient for less money and not be able to develop their services. That cannot be what the Government planned. If I have that totally wrong, I would like the Minister to tell me in his winding-up speech. That issue really concerns local doctors in the area.
	I want to move away from GPs, because, in many respects, the problem is not as serious in my area as it is elsewhere. What is fundamentally wrong and driving people up the wall is NHS dentistry, or should I say non-NHS dentistry? Like thousands and thousands of people in Northamptonshire, I have had to take out private insurance to continue to see my dentist. When I talk to my dentist, he makes a powerful case. Admittedly, he is standing over me with a drill at the time, but he makes the case strongly that the Government have forced him to do what he has done. Here am I and thousands and thousands of others paying through taxes for an NHS dentist, yet there are no NHS dentists in the area and I am paying 48 a month extra for insurance. That cannot be right. That cannot be how NHS dentistry should work.
	The Minister said nothing about dentistry in his opening remarks. I am sure that that was not an oversight. I think that he wanted to avoid a hugely embarrassing situation. The one thing that I can say with certainty is that NHS dentistry is worse now under this Labour Government than it was under Margaret Thatcher.
	Many things may have improved in the health serviceif funding for the health service is increased in real terms by 82 per cent., things should improve. The fact that most of that money has been wasted and that we have seen only a 23 per cent. increase in outcomes is down to the Government's inefficiency. The fact that the median waiting time is still longer under Labour than it was under the Conservatives is a minor point when we are talking about access, but the Minister has to answer this question: why is it that my constituents and others in Northamptonshire cannot see an NHS dentist? If one rings up and says, I must see an NHS dentist, the reply is, If you do not mind going out of the county, you can see one. That is the reality of NHS access in my county.

Michael Penning: We examined the methods in other countries in the Health Committee, but a completely different type of health care is provided in Denmark, Sweden and other countries.
	As always, it was a pleasure to listen to my friend the hon. Member for Wyre Forest (Dr. Taylor). He is renowned in the House, and particularly in the Health Committee, for his expertise. It is very important that we all understand the type of care that our constituents want. They do not want to go and meet a stranger, or see a different GP every time they need some care. They want the relationship provided by years of work together, often down the family line. Although GPs in Worcestershire were pressed, it is a crying shame that GPs from other parts of the country are coming down to Worcestershire, because Worcestershire GPs probably understand the hon. Gentleman's constituents much better and would represent the way forward.
	We are pressed for time, but I want to make a couple more comments. The hon. Member for Wyre Forest alluded to the fact that we must address the out-of-hours urgent care system. So many people are frightened and need help, and they do not know the myriad of numbers involved. I know that NHS Direct has tried desperately to get its number into the public's perception, but people still do not know it. The branded number that people know, 999, is sadly being abused on a daily basis. We must get another number branded quickly, before these numbers disappearthe European Union is progressing with these 116 numbers as we speak. He also mentioned the important NHS pathways software, and I have seen it working brilliantly in the north-east.
	My final point is about dentistry, which is the part of primary care missing from the Minister's speech. It is crucial that this Government address the mess that they have created by imposing the dentists' contract on this country. So many people cannot see an NHS dentist, but they deserve to do so, because that is what they pay their taxes for, and so it is about time that this Government scrapped their ludicrous contract.

David Evennett: I endorse what my hon. Friend says, and I am very concerned about it. It is perceived that finance is the bottom line.
	My concern is whether the other hospitals will be able to meet the need if we close A and E at Queen Mary's. In December last year the Princess Royal hospital in Farnborough had to turn away patients as it was unable to cope with the high demand. Three ambulances were diverted to Queen Mary's for three hours because of the influx of patients on 18 December 2007.
	There was an increase of about 32 per cent. in the number of A and E attendances at Queen Elizabeth hospital in Woolwich between 2001-02 and 2007-08. So I seriously believe that neither hospital could cope with the additional attendees that the closure of QM at Sidcup would cause.
	In 1988 I campaigned vigorously for part of my then constituency of Erith and Crayford to be included in the maternity services catchment area of Queen Mary's hospital because constituents were having to travel a long way for the services that they needed. We were fortunate in that campaign. The Government and the health authority listened, and the campaign was successful. Residents of Crayford were included in that catchment area. I fear that we are now looking at a retrograde step of closing maternity services at Queen Mary's, and other areas of Bexley will experience the same problems as my constituents had in the 1980s.
	Many constituents from Bexley and Sidcup have contacted my office to praise maternity services at the hospital, which are provided by hard-working doctors and nurses and other staff. The unit has an extremely good record. Again, capacity at other hospitals in south-east London is a concern. While more home births are being promotedwhich is good for those who want itthere will be issues for those who prefer hospital care and delivery. I understand that nationally in 2007, 42 per cent. of NHS trusts providing maternity services had to turn away women in labour because they were full. This is a worry that we will have in our area too.
	I know that the Princess Royal hospital had to divert patients from its maternity unit in March due to high activity and capacity issues. These are real concerns. I hope that the Minister will appreciate that we are closing facilities in Queen Mary's hospital in Sidcup when other hospitals are not able to cope. Yet the experts say that those hospitals could cope.
	I have received representations from GPs. They say:
	The plans for Maternity services in both Primary and Secondary care do not seem robust. Bexley will be left with a midwife-led birthing unit at QMH with no Consultant backup on the premises.
	Community midwives are being taken away from individual GP surgeries and grouped into clusters. This will cause great inconvenience to patients at large who will have to travel further for their care. The midwives will be unable to access patients medical records which are a necessary requirement.
	I note that in other parts of the country smaller maternity units are being maintained, so why not in Bexley? My hon. Friend the Member for Bromley and Chislehurst has alluded to the finance, and I will not go over that in view of the shortage of time. Many people believe that the building is safe, but what about the services? The hospital is being downgraded and services cut for financial reasons.
	I should like to ask the Minister a couple of questions. We know that a joint health overview and scrutiny committee referred the decision of the Picture of Health board to the Secretary of State in the summer. I should like to know when the decision is going to be made. Does the Secretary of State intend to refer the decision to the independent reconfiguration panel to ensure that there is independent scrutiny? We would like to know that independent people have looked at the decision and made a judgment. All of us who are campaigning against the downgrades and closures feel that to date that has not been done. As my hon. Friend said, it looks as if there was a done deal and the consultation was a sham. I hope that the Minister will be able to answer these important issues and that he will tell me positively that the case will go to the IRP.
	The hospital is not the only local health care issue. We have real concerns about the regrettable cuts made by the Bexley Care Trust, whose headquarters is in my constituency. Those cuts affect quality of life. Pensioners, for example, are disadvantaged by cuts to the chiropody service. Many of them now have to pay for the service and travel to clinics rather than have a free service in their home.
	Two years ago, I raised concerns with the Minister's predecessor about plans to redirect family planning services to GPs and about changes to speech and language therapy services. More recently, we have been concerned locally about the lack of NHS dentistry services. Those are quality of life issues.
	When my hon. Friend the Member for Hemel Hempstead (Mike Penning) spoke at the end of the previous debate, he made some important points about polyclinics. Many local pensioners are concerned about how polyclinics will affect them. The closing of GP surgeries in favour of polyclinics could have a considerable effect on early diagnosis rates. We are also concerned that the relationship between pensioners and their doctor will be breached because they will not always see the same doctor.
	Those are the concerns that are being raised locally. The fear is that Queen Mary's hospital may eventually end up as simply a super-polyclinic. That is a real worry to pensioners who rely on their doctor. People get to know their doctor, which makes them feel confident. Elderly people in particular value that relationship.
	I am pleased to have been able to raise these issues with the Minister. Will he give us some reassurance that there is no done deal on Queen Mary's and that there will be independent consideration? South-east London is different from other parts of London; we have particular issues and problems, whether transport or the location of hospitals. We deserve better health care for all the people in Bexley.